Health officials are scrambling to find the sources of bacteria that caused four cases of Legionnaires’ disease over the past month and resulted in one death in Honolulu.

The Health Department notified providers Wednesday morning of the death in a medical advisory and said two of the four patients had similar exposure and two others were completely unrelated. All were treated at The Queen’s Medical Center. The two related cases are suspected to have been acquired at the hospital, said state epidemiologist Sarah Park, who is investigating the cases reported in May and June.

“The focus right now is very much in the hospital, especially because of the high-risk patients that they have. We want to make sure everyone is protected as this investigation goes on,” Park said at an impromptu news conference at the medical center. “This is a bacteria that can take up to two weeks to grow. This is transmitted via water so we have to track down every potential water exposure these people had. We’re not leaving anything to any chance. It basically underscores the importance of every facility, not just health care facilities — hotel facilities, homes and such — to maintain our water wells.”

Queen’s, which uses water from its own private well beneath the medical center, is undergoing an extensive search to find the source of the bacteria and taking precautions to keep patients who are at the greatest risk of contracting the disease away from tap water in any form, said Dr. Erlaine Bello, a Queen’s infectious disease specialist. Legionnaires’ disease is primarily spread through inhaling aerosolized water droplets.

Most people do not become ill when exposed to the bacteria, but those with compromised immune systems are vulnerable to developing Legionnaires’ disease, which is serious because it has a higher fatality rate than other types of pneumonia.

“We are providing bottled water for drinking and personal hygiene like tooth brushing and face washing for immunocompromised patients,” such as cancer and transplant patients as well as those with severe underlying lung disease, she said. She added that the potentially deadly form of pneumonia can result in mortality rates as high as 70 to 80 percent, depending on a patient’s immune system.

The hospital has modified faucets, removed or changed laminar flow devices, increased water chlorination and is testing cultures in water samples throughout the facility since being alerted last week to the first case of Legionella. However, Queen’s is not considering evacuating patients at this time.

“Evacuation is an excessive, drastic measure. This is not a cause for alarm or panic,” Bello said.

Of the remaining three patients, one has recovered and two are still hospitalized and being treated for both legionellosis and other underlying conditions. All four cases were among patients well over the age of 50 who had other serious medical conditions. The incubation period for the disease is between two and 10 days.

The patient who died sometime in May had symptoms of pneumonia at the time of admission and “presumably got the infection before (the patient) arrived at the hospital,” she said.

Over the past 10 years, the Health Department said there have been four deaths related to the disease, including the recent case — one each in 2012, 2014, 2016 and 2018, though not all cases are reported to the state. All were Hawaii residents and all had at least one risk factor predisposing them to severe disease, Park told the Honolulu Star- Advertiser.

“Having an infection such as this on top of your already underlying condition can contribute to having a much more severe illness and unfortunately, in some cases, a poor outcome,” Park said.

The string of cases caused by a bacterial infection was alarming enough for Queen’s and the state Department of Health to issue a news alert Tuesday ensuring the public that health officials were “working closely with the Centers for Disease Control and Prevention to investigate these cases and all potential sources of Legionella exposure within and outside of the hospital.”

While Legionella is naturally found in freshwater lakes, streams and soil, it is a public health concern when spread in building water systems like shower heads and faucets, hot tubs and cooling systems. The disease is not readily transmissible from person to person.

The CDC said in a study last year that hospital- acquired Legionnaires’ disease can be particularly deadly. One in four people who get infected in a health care facility will die, the CDC said in a June 2017 Vital Signs report.

“Legionnaires’ disease in hospitals is widespread, deadly and preventable,” CDC Acting Director Anne Schuchat said in a news release at the time. “Controlling these bacteria in water systems can be challenging, but it is essential to protect patients.”

Legionella can grow in building water systems with low disinfectant levels, stagnant water or temperatures that are ideal for bacteria growth, the CDC said.

In 2016 the CDC received reports of 6,100 cases of the disease nationwide. People 50 years or older, current or former smokers, and those with chronic diseases or weakened immune systems are particularly vulnerable.

Legionella Fact Sheet by Honolulu Star-Advertiser on Scribd

Legionnaires’ Disease Fact Sheet by Honolulu Star-Advertiser on Scribd